An in-depth focus on the case of Sam Mansell

25/02/1999

Alexander Harris Partner Nicola Castle who acted for Sam, highlights the important aspects of this type of litigation.

Penny Mansell became pregnant at the end of 1986 and her antenatal period was uneventful. She was eventually admitted to hospital on 6th September 1987 at 5.30 p.m. under the care of her GP. She was 19 days + term and had been complaining of contractions since 1 p.m. The fetal head was unengaged and the cervix only 4 cm dilated indicating that delivery was a long way off. The midwives called Penny's GP but were unable to contact him. He eventually visited at 8.45 p.m. by which time the cervix was 6-7 cm dilated but the fetal head was still not engaged. The GP then left the hospital.

At 10 p.m. the cervix was 8 cm dilated but the head remained unengaged. The midwives discussed the matter with Penny's GP over the telephone and he was due to visit.

By 11 p.m. the cervix was 9 cm dilated, the fetal head remained unengaged but there was a dip in the fetal heart rate. The midwives attempted an internal examination at 11.50 and considered that the cervix was now fully dilated. The GP was again called for and he advised that Penny Mansell should commence pushing and he was to be informed of her progress.

Penny was transferred to the delivery room at 12.10 a.m. as she was very distressed. She was complaining of continuous pain between contractions and again her GP was informed. He arrived at 12.25 a.m. and performed an internal examination. He advised her to continue pushing.

At 12.45 a.m. Penny's GP finally discussed the situation with the consultant and the senior registrar as he was concerned at her lack of progress. Penny was eventually transferred to the Consultant Unit at 1.15 a.m. because of her failure to progress. The medical staff quickly discovered that Penny would require delivery by use of forceps and the locum consultant, was informed.

At 2 a.m. the medical staff determined that Penny should have a trial of forceps under a general anaesthetic which was administered at 2.30 a.m. The forceps were applied and the baby rotated to aid delivery. The locum consultant then pulled on the forceps twice but there was no descent and a drop in the fetal heart rate was noted after the second pull. A caesarean section was therefore performed and Sam was delivered at 2.58 a.m. He required intensive resuscitation upon delivery and spent a difficult time in the Special Care Baby Unit with his condition being complicated by fits requiring anti-convulsant medication.

The Injuries

Sam suffers from athetoid cerebral palsy. Essentially he is unable to control his movements and even at rest his arms and legs move erratically and uselessly. When he attempts a purposeful movement this becomes chaotic and distressing to Sam. Indeed, Sam permanently wears plasters on his fingers and toes together with extra pairs of socks and gloves to protect his hands and feet from injuries he sustains during his day to day life. Sam is regularly losing finger nails and toe nails which of course is painful in itself but becomes exacerbated when he strikes that limb again.

Intellectually Sam is intact and attends a main stream school. He is therefore a normal 11 year old boy trapped within a useless body.

Sam has difficulty with every single aspect of daily living. He requires direct assistance with all of the following:-

1. Eating and drinking
2. Bathing
3. Toileting
4. Moving
5. Playing


Sam is unable to walk or achieve any movement from one place to another without assistance. When in bed he requires turning regularly to ensure he does not develop pressure sores and other problems. He therefore requires 24 hour care.

Litigation

Litigation was commenced in May 1994 against both the GP and the Health Authority responsible for the Consultant Unit. In November 1995 both Defendants received the expert evidence upon which the Plaintiff relied. At that stage it was clear that although the GP had acted negligently we were unable to prove that his actions caused Sam's cerebral palsy which was likely to have been caused in the final few minutes of the labour. At this stage the Consultant Unit was responsible. Nonetheless, it should be noted that this particular GP failed in providing standard care in many respects and he was simply fortunate that causation could not be established.

Despite the fact that the Health Authority saw medical evidence in 1995 they did not admit liability until April 1998. During this time Penny relied upon the State to assist her with providing carers. This provision was totally inadequate to such a point that she was required to begin judicial review proceedings against Social Services who eventually increased the amount of care and assistance. Following the admission of liability in April 1998 an interim payment was obtained which has been used to fund a private care regime set up by a case manager which is currently working smoothly. Penny and Sam are also hoping to move to an adapted property which will make caring for him a great deal easier.

Quantum

At the time this case settled in October 1998 it was the largest medical negligence settlement to date. The award was £3,281,199. There are a number of reasons why the award was so high. Firstly, Sam enjoys a relatively good life expectancy which is often not seen in a person with such great physical disability. The multiplier agreed between the parties was 24.

Sam's care requirements alone amounted to almost £100,000 and when this is multiplied by 24 it can be seen that £2.4 million is made up of care alone. The Defendants did not agree that Sam required such a high level of care provision but did not provide cogent evidence to rebut the nursing care report.

The balance of the award was made up of the following:-

1. Accommodation costs
2. Therapies
3. Transport
4. Medical review
5. Dietetic requirements
6. Aids and equipment


Experts were required to produce reports in all of these areas in order to prove the case. There was therefore a significant number of people involved in this case from the outset. Currently, an investigation is underway into the feasibility of a structured settlement and private trust regarding Sam's money as every step needs to be taken to ensure that this money provides for his needs for the rest of his life.

Sam himself has been aware of the litigation and as far as he is concerned, the recent trip to Disneyland made some of it worthwhile.

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